What Works: Physician and Nurse Rounding Improves Patient Satisfaction

By Johnson, Bonne T.; Conner, Brian T. | American Nurse Today, December 2014 | Go to article overview

What Works: Physician and Nurse Rounding Improves Patient Satisfaction


Johnson, Bonne T., Conner, Brian T., American Nurse Today


In 2013, a provision of the Patient Protection and Affordable Care Act of 2010 (ACA) included the concept of value-based purchasing, a payment method where providers are held accountable for the quality and cost of the healthcare services they provide through a system of rewards and consequences based on achieving prespecified performance measures.

Value-based payments to hospitals during 2012-2014 are based on 17 clinical outcomes and 8 measures of patient perception assessed through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The 8 consumer based measures include 2 questions regarding communication between patients and the nurses and physicians. Communication is, therefore, an important measure of patient satisfaction and a factor in determining hospital reimbursement.

Communication also has been cited as a primary factor in poor patient outcomes, medical errors, and patient dissatisfaction. Improving communication between the nurse, the physician, and the patient is a key element in process improvement to attain quality outcomes and patient safety.

As part of a quality improvement project conducted in an 82-bed acute care facility in South Carolina, we found that standardized nurse-physician rounding improved patient satisfaction as measured by HCAHCPS scores. This article provides an overview of the project and results.

Planning

We retrieved monthly satisfaction scores for nurse and physician communication from the HCAHPS database for 12 months before implementation to use as a baseline measure for determining improvement.

All mentally competent patients, 21 years and older, discharged from the 36-bed medical/surgical floor on the hospitalist service were included in the study. Each patient received an HCHAPS survey sent to the home following discharge. Survey results were reviewed and tabulated by an outside agency and were available to the facility on a monthly basis.

Process

After receiving institutional review board approval and having nurses and physicians complete an education program about the project, we implemented the new rounding process in May 2013. The primary nurse accompanied the hospitalist during morning patient rounds. A defined

communication format (see Rounding tool.) was used to guide patient, physician, and nurse communication.

Rounding tool

The intervention used the P.A.T.I.E.N.T.[C] format, developed by Johnson, for nurse/physician rounding:

P- Plan of care discussed with the patient and family.

A- Anticipated discharge/transfer is reviewed with the patient and family.

T- Tests/diagnostic results are discussed with the patient and family.

I- Issues/concerns identified by the patient are resolved.

E- Explanation of medications, diagnosis, and prognosis with the patient and family.

N- Nurse provides feedback regarding assessment and pain control.

T- Thank the patient and encourage patient and family to write down questions.

To ensure compliance, nurses used an orange checklist to list patient rooms and note if rounds were made with the hospitalist on a daily basis. The charge nurse collected the checklists at the end of the day shift. A list of the hospitalist's patients was obtained and compared to the nurses' checklists and a daily compliance rate was entered into a spreadsheet. …

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